Simulation as an educational strategy in the development of critical and reflective thinking: A qualitative exploration

Today's health care environment has become exceedingly complex. The new environment mandates graduate nurses make competent clinical judgments while maintaining patient safety (AACN, 1997; Long, 2004). However, multiple studies have identified graduate nurses have difficulty transferring knowledge and skills to the practice setting (Clarke & Aikens, 2003; Del Bueno, 2005). Therefore, national organizations have challenged nursing educators to implement and evaluate educational innovations to promote the development of the critical and reflective thinking skills of nursing students (AACN, 1998, NLN, 2003; NCSBN, 2005). Simulation has been posed as an educational strategy to facilitate the learner's development of critical and reflective thinking processes (Gaba, 2004; NCSBN, 2005). Yet, experts have indicated research is still needed to demonstrate how learning can be facilitated through simulation (Gaba, 2004; Beamson & Wiker, 2005). The purpose of the research study was to explore the critical and reflective thinking processes used by senior baccalaureate nursing students during and immediately after participating in a simulated learning experience. Research methodology for the qualitative study was grounded theory based on the methodological position of symbolic interactionism. Verification strategies were included to support the criteria of trustworthiness and authenticity. Trustworthiness of the data was established through credibility, dependability, confirmability, and transferability. Data from audio taped guided reflection sessions and the researcher's annotated notes were analyzed using open, axial, and selective coding until theoretical saturation was achieved and confirmed. As the analysis progressed through the coding processes, the theoretical construct of Simulation as an Educational Strategy to Facilitate the Dynamics of Thoughtful Practice emerged. The phenomenon of Thoughtful Practice depicts the intricate relationships of the critical and reflective thinking processes required in providing safe, competent patient care. Thoughtful Practice is developed as the learner integrates the critical and reflective thinking processes through simulated learning ,, experiences throughout the curriculum. The results emerging from the data reflected learners were at different stages of - critical and reflective thinking processes. Additionally, the stages of both critical and reflective thinking were based on the learner's foundation in theoretical knowledge, skills competency, experiential knowledge, and mindset.